• Insurance

  • Many people pay for their insurance and do not know how it works. Here are a few words to know.

    Maximum:
    Most insurance plans will pay a set amount towards your dental work every year. Once they have reached that amount they will no longer pay for anything else. That is one reason why it is important to get your dental work done as you need it so you do not end up with a higher bill.

    Negotiated Fees:
    Insurance often negotiates fees with the dentist. That is the legal amount that the dentist is allowed to charge you whether or not you have met your maximum.

    Deductible:
    Many plans include a deductible. This is often $50. How a deductible works is sometimes confusing and complicated. Here is how it works. Say you need to get a filling done. Your insurance will pay 80 % of the negotiated fee. Let’s say the fee is $155. The insurance will only cover 80% of everything but the $50 deductible. So you subtract $50 and multiply the $105 by 20% to find your copay. Following that you add back on $50 to the 20%. It will look something like this.

    155-50= $105
    105*20%= $21
    $21+50= $71 copay

    Downgrading:
    Some insurances do not want to pay the full amount for molars. For things like crowns, or fillings on molars your insurance may choose to downgrade their payment. This means that they will pay their percentage of a front tooth and the patient has to pay the difference between the two.

    If you have more questions feel free to contact our office. 303-457-3046